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NEWS: Geoff Watts Gene therapy is in danger of being overhyped, expert says BMJ 2008; 336: 977-a [Full text]

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The perilous alliance between subjectivism and genetic promise

Ernesto d'Aloja, Michela Pintor, Francesco Paribello and Salvatore Pisu   (29 May 2008)

The perilous alliance between subjectivism and genetic promise 29 May 2008
Ernesto d'Aloja, Full Professor Legal Medicine Cagliari University School of Medicine, Michela Pintor, Francesco Paribello and Salvatore Pisu Send response to journal: Re: The perilous alliance between subjectivism and genetic promise	EDITOR – In his news report Geoff Watts accounts for the sensationalism surrounding and accompanying gene transfer therapy experiments. This is only one of the many ethical problems arising from gene therapy endeavour. Certainly, we believe that is undoubtedly wrong either to create illusions and over expectations putting pressure on scientists and clinicians and, even more, to create false hopes for patients. But this issue is only the tip of the iceberg. Gene transfer endeavour will represent an important therapeutic tool for medicine despite the growth of many ethical problems, as Kimmelman said in Nature Reviews - Genetics . At the same time it also represents an unique chance to focusing on the true concept of health and disease. We fear that in the last decades an in-depth shift has occurred from a realistic concept of disease to a nominalistic one. If so disease represents an ambiguous admixture of subjectivist perceptions and a consequence of changing cultural milieu. In the past, in particular, the conception of disease was grounded in the body functions. It was shown as a imbalance of humours or as a breaking, malfunctioning of same organs, tissue, cells or even molecules. The underlying principle was that all complex entities (as living organisms) can be, completely or in part, explained by the sum of the single component properties . Consequently, the disease was, in some way, objective. Many intellectuals today strongly criticize this approach, arguing that it inappropriately subordinates patient’s needs to science interest. We agree with H.T. Engelhardt when he quotes «clinical medicine begins from and return to the problems of patients» , providing that it doesn’t mean the disappearance of disease as an entity or even that disease or health as a noun have no objective reality . In fact, by accepting this interpretation of health and disease it would become impossible to set a clear boundary among the rightness of somatic genetic therapy, germ line gene transfer and genetic enhancement. As Harris and Chan stated ‘the treatment/enhancement is, in many senses, a red herring’6. So, without undervaluing the perilous attitude to overrate the “genetic promise”, we need to gain consciousness that the very ethical challenge is represented by the alliance between a nominalistic conception of disease and the genetic promise. 1 Watts G. Gene therapy is in danger of being over hyped, expert says. BMJ 2008; 336: 977. (3 May.) 2 Kimmelman J. The ethics of human gene transfer. Nature Reviews/genetics 2008; 9: 239-244. 3 Gilbert SF, Sarkar S. Embracing Complexity: Organicism for the 21st Century. Developmental Dynamics 2000; 219: 1-9. 4 Engelhardt HT. The foundation of Bioethics. 2nd edition. New York: New York-Oxford University Press, 1996: 216. 5r Bernard C. An Introduction to the Study of Experimental Medicine. New York: Dover, 1927: 67. 6 Harris J, Chan S. Understanding the ethics of genetic enhancement. Gene Therapy 2008; 15: 338-339. Competing interests: None declared